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Tom's Guide
07-06-2025
- Health
- Tom's Guide
'CBT-I is the gold-standard treatment for insomnia' — an expert shares his go-to method for helping people with sleep disturbances
According to the American Academy of Sleep Medicine, 12% of US adults are diagnosed with chronic insomnia, a disorder that makes falling asleep and staying asleep difficult. While treatment for insomnia can include medication, more and more people are turning to CBT-I (Cognitive Behavioral Therapy for Insomnia). This form of therapy is designed to address the root factors contributing to insomnia, rather than just medicating symptoms. But how effective is it? We spoke to Dr Aric Prather, Sleep Advisor to wellness app Headspace, and the Director of the Behavioral Sleep Medicine Research Program at the University of California at San Francisco, to find out more following the launch of Headspace's new CBT-I sleep programme Finding Your Best Sleep. Here's what he told us... "Cognitive Behavioral Therapy for Insomnia (CBT-I) is the gold-standard empirically supported treatment for insomnia, and should be the first line treatment for individuals with insomnia before embarking on pharmacologic treatment," says Dr Aric. CBT-I also addresses the anxiety that develops with unpredictable sleep "Unlike hypnotic medication, CBT-I addresses the perpetuating factors that drive insomnia, and provides the patient with science-backed strategies to improve sleep by consolidating sleep and entraining their circadian rhythm. "CBT-I also addresses the anxiety that develops with unpredictable sleep by incorporating relaxation techniques and psychological strategies like cognitive restructuring. "The goal is to help patients better regulate their sleep, find some success in sleeping, and build confidence and resilience." Get instant access to breaking news, the hottest reviews, great deals and helpful tips. "CBT-I focuses specifically on sleep and insomnia symptoms. Unlike other CBT therapies, CBT-I is heavily behavioral. We know quite a bit about what regulates our sleep biologically, so that's where we start. "Focusing on standardizing someone's wake up time, implementing stimulus control to reduce cognitive arousal in bed, and tracking sleep behavior via a sleep diary followed by restricting their time in bed to increase sleep consolidation can go a long way towards increasing the predictability at nighttime and reducing anxiety prior to and during the night." "CBT-I can certainly improve anxiety symptoms. In fact, several clinical trials demonstrate that individuals randomized to CBT-I show significant reductions in anxiety symptoms compared to those randomized to control conditions. "This isn't surprising given that poor sleep often leaves people more 'on edge' and anxious. Headspace also offers a guided program specifically for anxiety and depression, the CBT for Anxiety & Depression program, which incorporates CBT techniques specific to improving anxiety and depression symptoms. "The course has been shown to decrease anxiety & depression symptoms, improve sleep quality and positively impact mental health and wellbeing (results currently being prepared for peer review)." "Some people tend to benefit more from CBT-I than others, though much more research is needed to clarify these differences. There is little downside [to CBT-I], and it's likely to provide you with a greater sense of control over your sleep "There is some evidence that shorter sleepers with insomnia- those sleeping less than six hours, for example- may struggle with CBT-I more than longer sleepers. "This is likely because one of the active mechanisms for why CBT-I is effective is through time in bed restriction, which may not be as powerful in those already getting little sleep. "In my clinical experience, CBT-I may also be less effective in individuals with complex psychiatric or medical presentations. "In some cases there may be conditions or medications that are impacting sleep where CBT-I may not completely resolve the sleep concern." "While CBT-I remains the gold standard for treating insomnia, it isn't always accessible. Headspace's sleep course 'Finding Your Best Sleep' was created to expand low-cost access to effective sleep support. Unlike sleep medications, CBT-I does not carry any long term risk "The course expands access to proven sleep support by offering expert-led, self-guided sessions that can be completed anytime, anywhere. Included with a Headspace membership, it offers flexibility and affordability—removing common barriers to care. "The course has been clinically proven to improve insomnia after practicing just 10 minutes a day over the course of 18 days. "I hope that anyone who is struggling with insomnia will consider a trial of CBT-I in any way that is accessible to them. There is little downside, and is likely to provide you with a greater sense of control over your sleep experience. "Unlike sleep medications, CBT-I does not carry any long term risk. Moreover, the strategies learned through CBT-I can be useful well into the future and sleep changes as our lives unfold." "My suspicion is that stress and feelings of uncertainty are the most likely culprits of insomnia. For so many- too many- we feel like we are in a state of hypervigilance, and this results in nights of disturbed sleep. In turn, we often lack the emotional resources to deal with the stressors the following day, leading to yet another night of poor sleep. Thankfully, programs like CBT-I can help provide a roadmap to better regulate our sleep, and when coupled with stress management strategies, can help us cope with this stressful world." "First, I would say that they are not alone. In fact at least 30% of adults, if not more, are not getting adequate sleep. The second piece of advice is to take stock of your sleep life. Is it that you are getting sleep but don't feel refreshed? At least 30% of adults, if not more, are not getting adequate sleep "Is something disrupting your sleep? Are you so pressed for time that you are not giving yourself enough opportunity? The answer to these questions will lead to different solutions. "If you are worried about your sleep, the first step could be to talk to your doctor to make sure that you don't have a sleep disorder, like sleep apnea, disrupting your sleep. "If not and you're looking for a personalised approach, consider trying CBT-I through a sleep specialist, I always suggest that people explore the Society for Behavioral Sleep Medicine directory to find someone in their region."
Tom's Guide
08-05-2025
- Health
- Tom's Guide
Trouble sleeping? Headspace's new insomnia-fighting course could get your rest back on track, study finds
New peer-reviewed research has found that a better sleep program from popular mindfulness app Headspace reduced symptoms of insomnia in 29% of participants with just 10 minutes daily practice. Getting better sleep at night also helped lower levels of depression among participants, leaving them feeling more rested and hopeful for the day ahead. Finding Your Best Sleep by Headspace is an 18-day self-guided program that incorporates Cognitive Behavioral Therapy for Insomnia (CBT-I) and Mindfulness-Based Stress Reduction (MBSR) among other evidence-based techniques to help users reduce racing thoughts and restlessness at night, and build lasting better sleep hygiene habits. Around one in three adults in the US aren't sleeping enough and while Cognitive Behavioral Therapy for Insomnia (CBT-I) offers an evidence-based approach to better sleep, a lack of practicing therapists means it can be hard to access and expensive. Cognitive Behavioral Therapy for Insomnia (CBT-I) is an evidence-based approach that aims to reduce insomnia by changing the behaviors and thought patterns around sleep. During the course of the study, 132 adults with clinical insomnia were assigned to either the Headspace sleep program or a control group. Those in the sleep program followed "Finding Your Best Sleep"; an 18-day course that uses 10 minute daily sessions based on CBT-I to target insomnia Participants were required to report on their sleep and mood pre-intervention, during intervention and post-intervention. Get instant access to breaking news, the hottest reviews, great deals and helpful tips. Those in the Headspace group showed a 29% reduction in self-reported insomnia symptoms compared to those in the control group, as well as reporting an improvement in overall sleep quality. CBT-I is considered one of the most effective methods for reducing insomnia, but cost and accessibility means it isn't always an option for those struggling with their sleep. The Headspace app aims to offer a flexible and affordable approach to CBT-I, packaging the basic principals into a course you can complete on your own time. 'These compelling research findings represent a novel and scalable way to help individuals get the sleep they need,' says Dr. Aric Prather, Director of the Behavioral Sleep Medicine Research Program at the University of California at San Francisco. 'With nearly 30% of adults reporting sleep difficulties, access to this new program could be game-changing.' Users who engaged with the Headspace Finding Your Best Sleep program didn't just report benefits to their sleep — they also found their mood improved. Participants reported reduced stress, anxiety and depressive symptoms while using Headspace, and these positive results were further observed during the three week follow-up. Sleep deprivation and insomnia are linked to anxiety, irritability and depression while those who experience long-term sleep deprivation often struggle to regular their emotions. Harvard Health even describes a good night's sleep as the "best way to improve your mood." While the Headspace sleep program takes 18 days to complete, this study indicates that the advantages might last well beyond that initial period. Three weeks post-intervention — after completing the program — participants were asked to report on their sleep and mental health. Users who had engaged with Finding Your Best Sleep continued to note improved sleep and mood compared to pre-intervention. Among the control group, who hadn't completed the course, little difference was observed. CBT-I aims to create a healthier attitude towards sleep, removing the pressure many of us feel to get a solid eight hours every night... and the disappointment when we inevitably fail to meet those targets. When successful, this can lead to a long-term reduction in insomnia. CBT-I focuses on your thoughts and behaviors around sleep, identifying issues that are contributing to your insomnia to restructure your approach to bedtime. This process will typically take place over several sessions, typically administered by a healthcare professional. However, currently only a small number of trained CBT-I therapists are operating in the US, which can make the treatment hard to access. If you are experiencing insomnia and think you might benefit from CBT-I, we recommend speaking to your doctor about available treatment plans. Mindfulness for better sleep helps you adjust your approach to rest. Instead of chasing unattainable perfection, you focus on practicing a healthy routine. Here are some methods to get started...
NZ Herald
30-04-2025
- Health
- NZ Herald
Phthalate chemicals in plastic linked to 350,000 deaths from heart disease
Phthalates are a set of chemicals that are added to plastic to make it more stretchy, soft or flexible. In lotions, shampoos and perfumes, phthalates can be used to retain scents. But the chemicals – which are so common that some researchers call them ' everywhere chemicals ' – have attracted widespread concern from scientists. In epidemiological studies, phthalates have been linked to male fertility problems, heart disease, obesity and ADHD. The United States allows nine kinds of phthalates to be used in food packaging. They are an example of what scientists call 'endocrine-disrupting chemicals,' which can tweak and change the hormones in the body, causing multiple health problems. 'We already know that phthalates are toxic chemicals,' said Tracey Woodruff, a professor of obstetrics, gynaecology and reproductive health at the University of California at San Francisco, who was not involved in the study. In recent years, she pointed out, scientists and environmental organisations have pushed lawmakers to get phthalates out of food packaging and other plastics. 'This just shows why that's a good idea,' Woodruff added. Kevin Ott, the executive director of the Flexible Vinyl Alliance, which represents the makers of polyvinyl chloride, said in an email that many studies on the health risks of phthalates do not meet the highest standards of evidence. The Food and Drug Administration confirmed as recently as 2018 that phthalates are not clearly linked with any health effects, Ott added. The new study drew on surveys from around the globe that evaluated exposure to DEHP, one particular type of phthalate, through urine samples. Researchers then matched exposure to the chemical to increased risk of cardiovascular death. They found that phthalates contributed to 13% of all deaths from heart disease in people between ages 55 and 64 globally. In the United States, it was around 10%. Cardiovascular disease is the leading cause of death worldwide: In 2021, an estimated 20 million people died because of heart disease. Trasande says that while 13% may seem like a high number, phthalate exposure may overlap with and exacerbate other risks. Phthalates are believed to create excess inflammation in the body, and they are linked with other conditions that increase heart disease mortality, such as obesity and high blood pressure. Some of the increased risk of heart disease from obesity, for example, could be from phthalates. The chemicals are also found more commonly in highly processed foods, another risk factor for death from heart disease. Scientists estimate that air pollution, which also can contain tiny plastic particles, is linked to 20% of all cardiovascular deaths globally. Recent research – albeit with a small sample size – has also found that the presence of microplastics or nanoplastics in the carotid artery increases the risk of heart attack, stroke or death. Researchers are trying to understand the extent to which those tiny plastics can carry chemicals like phthalates with them. But people with more phthalates in their bodies are probably more exposed to plastics, and therefore to microplastics and nanoplastics as well, Trasande said. 'It could be the chemicals that are being delivered, or it could be the micro and nanoplastics,' said Trasande. 'And that's really where the field needs to go scientifically.' Other research looking at deaths from phthalates has come to similar results. One study published late last year found that phthalates were responsible for about 164,000 deaths worldwide in 2015, most because of heart disease and high blood pressure. That study examined just 40 countries, while the new study looked at around 190. While animal studies have also found connections between phthalates and heart disease, some researchers say more human studies would help solidify the link. 'It would be important to have someone do a systematic review on phthalates and cardiovascular events,' said Woodruff. 'But it's just a new area.' For now, scientists continue to push for more monitoring of the chemicals in plastic. In most countries, companies are not required to reveal chemical additives to plastics, which include things like phthalates, BPA and flame retardants. Many of those plastics end up in low-income countries with mountains of plastic waste for recycling or disposal. 'They are the receivers of all the plastic garbage,' Woodruff said. 'And the phthalates are going to be there, too.'
Boston Globe
29-04-2025
- Health
- Boston Globe
Common chemicals in plastic linked to over 350,000 deaths from heart disease
While the researchers acknowledge that exposure to phthalates coincides with other risk factors — such as obesity and metabolic disorders — the findings add to the growing evidence that chemicals used in plastics come with serious health risks. Phthalates are a set of chemicals that are added to plastic to make it more stretchy, soft, or flexible. In lotions, shampoos and perfumes, phthalates can be used to retain scents. But the chemicals, which are so common that some researchers call them 'everywhere chemicals,' have attracted widespread concern from scientists. Advertisement In epidemiological studies, phthalates have been linked to male fertility problems, heart disease, obesity, and ADHD. The United States allows nine kinds of phthalates to be used in food packaging. They are an example of what scientists call 'endocrine-disrupting chemicals,' which can tweak and change the hormones in the body, causing multiple health problems. Advertisement 'We already know that phthalates are toxic chemicals,' said Tracey Woodruff, a professor of obstetrics, gynecology, and reproductive health at the University of California at San Francisco, who was not involved in the study. In recent years, she pointed out, scientists and environmental organizations have pushed lawmakers to get phthalates out of food packaging, and other plastics. 'This just shows why that's a good idea,' Woodruff added. Kevin Ott, the executive director of the Flexible Vinyl Alliance, which represents the makers of polyvinyl chloride, said in an email that many studies on the health risks of phthalates do not meet the highest standards of evidence. The Food and Drug Administration confirmed as recently as 2018 that phthalates are not clearly linked with any health effects, Ott added. The new study drew on surveys from around the globe that evaluated exposure to DEHP, one particular type of phthalate, through urine samples. Researchers then matched exposure to the chemical to increased risk of cardiovascular death. They found that phthalates contributed to 13 percent of all deaths from heart disease in people between ages 55 and 64 globally. In the United States, it was around 10 percent. Cardiovascular disease is the leading cause of death worldwide: In 2021, an estimated 20 million people died because of heart disease. Trasande says that while 13 percent may seem like a high number, phthalate exposure may overlap with and exacerbate other risks. Phthalates are believed to create excess inflammation in the body, and they are linked with other conditions that increase heart disease mortality, such as obesity and high blood pressure. Some of the increased risk of heart disease from obesity, for example, could be from phthalates. The chemicals are also found more commonly in highly processed foods, another risk factor for death from heart disease. Advertisement Scientists estimate that air pollution, which also can contain tiny plastic particles, is linked to 20 percent of all cardiovascular deaths globally. Recent research — albeit with a small sample size — has also found that the presence of microplastics or nanoplastics in the carotid artery increases the risk of heart attack, stroke, or death. Researchers are trying to understand the extent to which those tiny plastics can carry chemicals like phthalates with them. But people with more phthalates in their bodies are probably more exposed to plastics, and therefore to microplastics and nanoplastics as well, Trasande said. 'It could be the chemicals that are being delivered, or it could be the micro and nanoplastics,' said Trasande. 'And that's really where the field needs to go scientifically.' Other research looking at deaths from phthalates has come to similar results. One study published late last year found that phthalates were responsible for about 164,000 deaths worldwide in 2015, most due to heart disease and high blood pressure. That study examined just 40 countries, while the new study looked at around 190. While animal studies have also found connections between phthalates and heart disease, some researchers say more human studies would help solidify the link. 'It would be important to have someone do a systematic review on phthalates and cardiovascular events,' said Woodruff. 'But it's just a new area.' For now, scientists continue to push for more monitoring of the chemicals in plastic. In most countries around the world, companies are not required to reveal chemical additives to plastics, which include things like phthalates, BPA, and flame retardants. Many of those plastics end up in low-income countries along with mountains of plastic waste for recycling or disposal. Advertisement 'They are the receivers of all the plastic garbage,' Woodruff said. 'And the phthalates are going to be there, too.'
Yahoo
13-03-2025
- Health
- Yahoo
Five years after the Covid pandemic, health experts are finally ready to say that it's over
Five years after the start of the Covid pandemic that killed more than one million Americans and shut down the world, health experts are really ready to say that it's over - at least, for now. After evolving through multiple variants, including omicron, the virus has become more consistent with an 'endemic' disease, they say. 'This pandemic did what pandemics usually do — settle into endemicity, which means constant vigilance on our part,' requiring ongoing vaccination and surveillance to keep the virus under control, Monica Gandhi, an infectious disease expert at the University of California at San Francisco, told The Washington Post on Thursday. The endemicity of Covid is largely agreed upon in the medical community, William Schaffner, a professor of infectious diseases and preventive medicine at Vanderbilt University, told the publication. However, it is worth noting that there are multiple definitions of what 'endemic' means. For example, an endemic disease outbreak occurs when a disease is consistently present but also at predictable and manageable levels, according to doctors at UCLA Health. The Columbia Mailman School of Public Health defines endemic as limited to a particular region, making its spread and infections predictable. Malaria is one example, which is most common in sub-Saharan Africa. Influenza is also a common endemic virus. Experts say that a de-escalation in terms to an 'endemic' is partially due to the evolution of the virus to less deadly variants, that many of those most vulnerable had already been killed and from immunity acquired through infection and vaccination. The development of vaccines was a key step toward the pandemic transitioning into an endemic outbreak, the American Lung Association said. It's been two years since President Joe Biden ended the coronavirus national emergency and the World Health Organization declared an end to Covid as a public health emergency. The agency noted then that the risk still remained but said the pandemic had been 'on a downward trend' for 12 months that 'has allowed most countries to return to life as we knew.' Since then, some Americans have gotten booster shots of the vaccine — but the public's response to the threat of infection has also been different. Fewer and fewer people wear masks in public spaces or isolate when they feel sick. There's a waning interest in getting booster shots as well. Notably, death and hospitalization levels are not nearly as high as they once were. Flu deaths have surpassed Covid deaths this year. In 2023, Covid was projected to be the 10th leading cause of death, according to researchers. Some people remain skeptical of whether Covid is an endemic. In a recent Axios and Ipsos survey, 46 percent of respondents somewhat or strongly disagreed that the pandemic was over. 'We've decided, 'Well, the risk is OK.' But nobody has defined 'risk,' and nobody has defined 'OK,'' Dr. Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told The New York Times last year. The virus is still out there, but rates of test positivity, hospitalizations and emergency department visits are all down, according to the most recent CDC data. For some, Covid has been endemic for a while. The Centers for Disease Control and Prevention's former director Dr. Mandy Cohen called the disease endemic last August. 'Endemic doesn't necessarily mean good,' Bill Hanage, an associate professor of epidemiology at Harvard T.H. Chan School of Public Health, said last year. 'Tuberculosis is endemic in some parts of the world, and malaria is endemic in some parts of the world. And neither of those are good things.' It's also possible to move back to a pandemic phase, Dr. John O'Horo, a Mayo Clinic infectious diseases specialist, explained in 2022. "This isn't a one-way door. Continued vigilance and vaccination will be required at some point in the future to prevent another pandemic from disrupting our lives the way that we've seen...' he said.
